Atrial Tachycardias After Atrial Fibrillation Ablation
What Matters for Identification of the Region of Interest?
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See Article by Casado Arroyo and Laţcu et al
Electrical isolation of pulmonary veins (PVs) is the cornerstone of catheter ablation for atrial fibrillation in clinical practice but may potentially predispose to iatrogenic left atrial tachycardias (ATs) particularly in combination with additional left atrial ablation. The reported incidence of ATs after atrial fibrillation ablation varies from 2.9% to 40% highly dependent on index ablation strategies.1–4 Compared with PV isolation alone, an aggressive strategy can be associated with a higher risk of developing ATs during follow-up.5,6 In the setting of PV isolation alone, recurrent ATs typically have a focal origin in nature from reconnected PVs and may account for up to 80% of AT incidence, irrespective of segmental or circumferential ostial PV ablation.1,7 After extensive left atrial ablation, the majority of ATs are macroreentrant, and the reentrant circuits most commonly traverse incomplete or recovered linear lesions (such as left atrial roof or mitral isthmus lines) or rotate around other anatomic obstacles.3,8,9 These ATs, especially the latter, are frequently incessant and poorly tolerated because of relatively rapid ventricular response. Symptoms experienced may be even worse than those from atrial fibrillation before the index ablation. Thus, there is often a therapeutic imperative for ablation of ATs in such scenarios because management of these tachycardias is difficult using a pharmacological approach. However, detailed mapping of these arrhythmias based in part on activation time is well known to be challenging …